Section 230-RICR-20-30-9.4 - General Requirements - Certification, Recertification, and Material ChangeA. A health care entity operating a network plan shall: 1. Not enroll consumers into its plan unless the Commissioner has certified the network plan pursuant to the Act and these regulations;2. Be required to submit a recertification application every two (2) years in form and content consistent with instructions by the Office for that purpose;3. Notify the Office at least thirty (30) calendar days prior to any substantial systemic change to any of its certified network plans; and4. Upon a determination by the Office that a substantial systemic change constitutes a material change, file an application consistent with instructions and requests for information issued by the Office for that purpose.B. A health care entity applying for certification, recertification or material change approval shall provide information to the Office sufficient to enable the Office to determine/evaluate compliance with the requirements of the Act and these regulations according to instructions issued as a guidance document by the Office for that purpose.C. The cost of the application processes (certification, recertification, and material change), application reviews, complaint processing, investigations, and other activities related to obtaining and maintaining network plan certifications shall be borne by the health care entities, as determined by the Commissioner, including: 1. An application fee established by the Commissioner for each application processed, not to exceed five hundred dollars ($500), which fee must accompany each application.2. The total cost of obtaining and maintaining a certificate under this Act and in compliance with the requirements of the applicable rules and regulations shall be borne by the applicant and shall include one hundred and fifty percent (150%) of the total salaries paid to the personnel engaged in certifications and ensuring compliance with the requirements herein and the applicable rules and regulations.3. These monies shall be paid to the Commissioner to and for the use of the office and shall be in addition to any taxes and fees otherwise payable to the state.4. The Commissioner may not issue a certification, recertification, approval of a material change, or may suspend a currently certified network plan, if a health care entity fails to pay any of the fees, assessments and costs noted above in a timely manner.230 R.I. Code R. 230-RICR-20-30-9.4
Adopted effective 12/16/2018